Planter Fasciitis

Some time ago, I mentioned I was having issues with what I believed to be plantar fasciitis. After nearly two and a half months of seeing little improvement and going stir crazy, I decided it was time to see a foot doctor. I've been hiking only four times since the beginning of September and have been taking it easy in hopes it would heal on its own but no dice. 

My visit to the podiatrist wasn't a very good experience. I had a lot of questions and when I tried to ask, he repeatedly interrupted me mid-sentence. After doing this a number of times, I gave up on asking anything else. Throughout the visit, he tried to sell his custom orthotics to me and when he wasn't trying to sell them, he was trying to sell me a set of socks designed to help with plantar fasciitis. What questions I had, he dished them off on a physical therapist who worked in the same building. When I asked the physical therapist, he told me straight up that he didn't know (kudos to him, at least he was honest). So basically, I dealt with a salesman in a white coat. 

Needless to say, I was unhappy with the doctor and walked out of his office with the same amount of questions I walked in with. To give you an example of what I mean, at one point during the visit, I asked the doctor if it was ok to go hiking again and his answer was a quick "sure you can". No insight or ideas on if I should take it easy and cut down on the distance, no recommendations on methods I could try to relieve the pain (exercises, stretching), no suggestions on if I should pay more attention to my pace and/or adjust how I walk, no advice on if I should avoid hiking too many hills, etc. But hey, here's a set of $300 orthotics and a $25 pair of socks I can put you in. No thanks, I wasn't spending another penny on this doctor, declined both, and opted for a second opinion instead. More on this later.

I don't know about anyone else but when I have questions about my personal health, I want answers from someone who's a professional in their field, not a salesman in a white coat who's going to interrupt me repeatedly and leave me with the same questions I walked in with. In the research that I've done since the pain started, the recommendations I've seen most for helping plantar fasciitis heal is rest, ice, and stretching, not more walking/hiking with continued impact to the area that's hurting. I'm not the expert though, that was supposed to be his job. Thankfully I have benefits but I still wasted $40 for him to confirm what I already knew when he diagnosed me with plantar fasciitis. Thanks buddy...

In the months since the pain set in and leading up to my visit with the podiatrist, I've tried numerous different types of insoles in hopes one of them would help to alleviate the pain. The only ones that helped until recently were Dr. Scholl's Active Series which really didn't provide enough support to keep me comfortable. Most of the others I tried were either tossed in storage or returned to where they were purchased. However, something good did come out of the visit and that's where the physical therapist came into play. 

Since my appointment with the podiatrist, I've been going to physical therapy once or twice a week depending on our schedules and thankfully have noticed some improvement. Before starting physical therapy, I was in pain every day but now that I've been going, it's hit or miss if my foot will feel pain from one day to the next. I'm making progress and have been more optimistic as of late but what's confusing is when I experience pain, it's completely random. I'll go a few days without pain, then back to having my foot nag me all day, then back to not having any pain again. Regardless of if I perform or don't perform the recommended icing and stretches on a given day, it's a guess on if I will experience pain from one day to the next. There have been times where I did the icing and stretches and was in pain the next day and others where I did them and was fine. The same applied if I chose not to do them.

There seems to be no rhyme or reason to how, when, or why this happens and pinpointing it has been equally difficult. I told my physical therapist about the random pain and his question to me was, "what are you doing differently?" to which I didn't have an answer, and I really still don't. Since my foot started hurting, I haven't done much as far as strenuous activity and definitely nothing that would create a randomly hurting foot from one day to the next. During the week, I don't often go anywhere but home since it's dark by the time I get done work and during the weekends, I've been careful not to do anything to agitate it.

Another question I have that will likely never be answered is how and when it happened in the first place. I know that after my hike at Peace Valley Park in the beginning of September where I walked extensively on a paved surface was when the pain in my foot really set in. Usually within a day after a long hike, my feet would be fine. Not this time and since then, the pain continued daily until I started going to physical therapy. I could have injured it before then and didn't notice it until after that hike and will likely never know.

There's also the question of the type of insoles I was using at the time that had been purchased about a month before the pain set in. These insoles are shaped nicely and provide good support to my arches but have almost no cushioning in the heels. I think this could have also been a reason for the problem as well. The reason I purchased the insoles in the first place was because of my hiking boots and how thin the rubber soles are in them. As I was hiking, I could feel everything I stepped on through the bottom of my foot. Small rocks, tree roots, sharp edges, you name it. If I stepped on it, I felt it. I thought that using a stiffer insole would help alleviate some of the pain my feet were in at the end of a long day of hiking. I didn't feel as much with the insoles but this could have also been one of the contributing factors to where I am now. 

So the questions linger. Was it walking on a paved surface as compared to a natural trail? Was it the number of times I went hiking using insoles that had little cushioning and gradually bruised and/or tore the plantar fascia under my heel? Was it the change from a more flexible insole to a stiffer one? Was it because of the thin flexible soles in my hiking boots? Did it happen because I was pushing myself too hard? I'm willing to go with all of them but I really wish I knew exactly when and how it happened so I'd know how to correct it instead of guessing. I was lucky and recognized what the pain was relatively quickly and I'm thankful for that. In my research, I've read horror stories from commenters on some of the blogs I visited who were laid up for long periods of time, could hardly walk, and were in excruciating pain where the pain I feel is enough to get my attention but not so painful that it made walking very difficult.

I mentioned earlier that I had opted for a second opinion. On December 15th, I visited a different podiatrist who was actually patient with the patient, listened to what I had to say, and provided insight that was helpful. My only wish is that I could have remembered all the questions I had when I visited the first podiatrist. He discussed some options with me and at first put me in a night splint that will keep the plantar fascia in a more stretched out position which is supposed to help. I decided I wasn't ready for that just yet. As I mentioned, the pain in my heel is enough to be a nag but no so much that I'd want to attempt sleeping with a big plastic boot on my foot. 

The next option and one that I felt was worth a shot first was taping. He used medical tape, a few pieces of felt-type material for padding, and securely wrapped my heel and arch. Not so tight that I couldn't move my foot, but enough so that the heel and arch had a good amount of support. I could still walk and at first it looked a bit like, as the doctor put it, "walking like Frankenstein". Once the tape stretched out a little bit, I returned to walking normally and let me tell you, it made a huge difference. It was near instant relief from the pain and the first time since September where I was comfortable for more than a few days in a row. It made me wonder why it is the previous podiatrist I visited didn't even mention or attempt taping. Actually I don't wonder, he was trying to sell his product.

I'm happy to see progress being made and that it seems I'm headed in the right direction. I did make a bit of a mistake and put a different insert in the shoe of the injured foot (one that was less thick) and it ended up making another part of my foot hurt. With the padding the podiatrist put in with the tape and the slightly raised arch of the insole, it was too much support and was digging into my arch in the middle of my foot. Another lesson learned and one I won't soon forget. The last thing I want to do it make it worse!

So, what does one do if they have or think they may have plantar fasciitis? Among the many medical websites and blogs I've been on, there seems to be some contradicting information on ways to alleviate and prevent the pain but the majority of them agree on the initial treatment. I'm no medical expert and in no way claim to be so take these suggestions with a grain of salt. What may work for one may not work for another. 

First and foremost, if your heel/arch is in pain that doesn't go away on its own, you should see a foot doctor (and hope they don't try for the most expensive solution first) and get an accurate diagnosis. It could be plantar fasciitis, a bone spur, a stress fracture, or a number of other conditions. It would be best to know what the problem is before starting treatment. Here are some of the recommended methods for treating plantar fasciitis:

• Rest your feet and avoid any strenuous activities that may cause the problem to get worse. Speaking from experience, this totally sucks but if you want your foot to heal, you're going to have to deal with it. My doctor gave me the go-ahead to go hiking recently and when I did, I think I re-agitated it so this could be a bit of a setback although it's still not as bad as it originally was.

• Ice the plantar fascia by freezing a bottle of water and rolling your foot on it. I usually wear one of my hiking socks when doing this since direct contact with the frozen water bottle would be too cold. It's going to hurt but make sure you apply pressure to the affected area. I have one spot just under my heel that when I roll over it the first few times, it's a pretty sharp pain but it tends to ease up after applying pressure for a few moments. If time allows, you can do this a few times a day or whenever your foot is in pain.

• Similar to icing the plantar fascia, rolling your foot on a ball of sorts (lacrosse ball, tennis ball, golf ball, ball of yarn, etc.) is said to help as well. I prefer using the water bottle with ice since it's basically killing two birds with one stone. Using a ball will be a little more concentrated to a particular area since there's less of the surface pressing against the bottom of your foot. Like with the frozen water bottle, you want to apply pressure, as much as you can take. You can also use this in conjunction with the icing. Another idea would be to put the ball in the freezer before rolling your foot on it.

• Stretching, stretching and more stretching. Stretch your calves, your Achilles tendon, the muscles around the shin, and the plantar fascia a few times a day. It wouldn't hurt to stretch the hamstrings either. Before you even get out of bed, stretch the fascia for a few minutes. After doing my research, I recall a number of times hiking where I would feel my legs, particularly my calves tightening up quite a bit, especially when going uphill. It turns out those tight muscles can contribute to plantar fasciitis which had I known about at the time, I would have taken a break and stretched before continuing. Adopt a stretching regimen and stick to it even after you get relief, you don't want to have a recurrence. Stretch before, during, and after whatever activity you partake in.

• Tape the arch and heel. I can attest to taping since it brought me near instant relief from the pain. Despite the mistake I made by putting an insole in the shoe with the injured foot, the relief I felt after the good doctor taped me up made a big difference.

• Purchase a good set of insoles. I mentioned Dr. Scholl's insoles earlier and after much research along with trial and error, purchased a set of Powerstep ProTech full length insoles which are very comfortable and brought me some relief from the pain as well. They get excellent reviews with a lot of them mentioning plantar fasciitis. I'd recommend getting the full length insoles regardless of the brand you choose. The 3/4 length or shorter ones tend to shift while inside your shoe/boot. There are also a number of other insoles you can try that get good reviews.

• If your shoes/boots are old and worn out, trash them and get a new pair. I bought my hiking boots earlier this year and they've had their share of miles but I don't consider them to be worn out, not yet at least. As I mentioned though, the soles of my hiking boots are quite thin and offer little support under the arch area. Giving the soles in my boots are so thin, I did purchase a new pair of hiking shoes. Partly because my daily wear sneakers weren't wide enough and were making my toes hurt, and the other part was because the mid-soles in them are more stiff and durable. There seems to be some conflicting information about what type of footwear is better and if a more stiff sole is better or if you should work towards going minimalist. If you're deciding on going minimalist, do your research and don't jump in head-first. Regardless, if your footwear is old and beat up, you should consider purchasing a new pair. I'm leaning towards having shoes with a more stiff mid-sole so my arch isn't being stretched as much as it was with my other hiking boots. 

• See a physical therapist. Icing, stretching, tape, insoles, etc. are all supposed to help and can be done at home but for me, the physical therapist was also doing electrical stimulation on my foot which I believe is a good part of why my heel is starting to feel better. Unless you know electricity well enough to make one of these machines on your own, you're stuck going somewhere that has this treatment available. There's also the massage therapy aspect of physical therapy. My current physical therapist massages my feet, more accurately my heel but I've noticed in my research that there's more to this. From what I've learned with my limited experience, the foot, Achilles, shin (muscles) and calves can all contribute to your pain and can also lead to pain in the ankles, knees, hip and back if the fascia is too tight. I'm not sure if it's from plantar fasciitis but I can definitely attest to the back pain. There were times when I went hiking where within a few miles, my lower back hurt so much, it was hard to move. 

• Other treatments that I'm not going to cover include taking anti-inflammatory medicines such as ibuprofen or naproxin which is self-explanatory, night splints, a walking cast, cortisone shots (which I will refuse even if the pain gets that bad) and in a worst case scenario, surgery. There are also some additional stretching exercises you can try that I did not cover.

I could probably go on for several more paragraphs about plantar fasciitis but I think I've bored everyone enough. What I can tell you though, is that this is no laughing matter and if you are experiencing pain in your heel that doesn't subside, don't try to push through it as it could only make matters worse (and likely will). As I've already mentioned before, you will also need to be patient since there is no quick fix solution to this problem. Some have healed quickly where others such as myself have been dealing with it for an extended period of time.

Below are a number of links to sources where I pulled some of my information from. Don't overdo yourself too much though. Sometimes, too much information will put you on overload! There's a wealth of information out there and I don't claim any of the below will be your solution if you have plantar fasciitis, but I do think the information on these sites will be useful.

Mayo Clinic - Plantar Fasciitis
WebMD - Plantar Fasciitis
Ask Well: Plantar Fasciitis Relief
A Complete List of Plantar Fasciitis Exercises
Nine Best Plantar Fasciitis Insoles
The Plantar Fasciitis Survival Guide
Plantar Fasciitis, Heel Spurs, Heel Pain 
Dr. Prubit on Plantar Fasciitis and Heel Pain
What Shoes are Best for Plantar Fasciitis and Heel Pain - Most of this website is an advertisement for their eBook but this article has some decent information on the type(s) of shoes one might want to invest in.
Livestrong - Plantar Fasciitis - There's quite a bit of redundancy in the articles on this website but there's also some good information as well.
  
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